改良LBL-PBL结合Mini-CEX模式在心脏外科实习教学中的应用

目的 探讨改良以授课为基础的学习（lecture-based learning，LBL）联合以问题为基础的学习（problem-based learning，PBL）结合迷你临床演练评估（mini-clinical evaluation exercise，Mini-CEX）在心脏外科临床实习教学中的效果。 方法 选取2019年6月至2021年6月在西部战区总医院心脏外科实习的临床医学专业共80名本科生，完全随机分为LBL-PBL（LP）组（n=40）和LBL-PBL+Mini-CEX（LPM）组（n=40），观察LPM组学生在入科时（T₁）、入科1周（T₂）及入科2周（T₃）的Mini-CEX评分，同时比较LP和LPM组出科理论考核成绩和临床操作成绩（病史采集和书写能力、体格检查、医学检查检验判读能力、外科基本操作能力），同时问卷调查患者对两种教学方法的满意度。结果LPM组实习生T₂和T₃时Mini-CEX评估量表的各项指标均较T₁时有不同程度的提高，T₃时各项指标均达到优秀水平，且评分较T₁明显升高（P<0.05）；LPM组的理论考核成绩、临床操作成绩中病史采集和书写能力、体格检查以及医学检查检验判读能力明显高于LP组，差异具有统计学意义（P<0.05），但两组间外科基本操作能力成绩无明显差别。LPM组患者满意度明显高于LP组（P<0.05）。 结论 采用改良LBL-PBL结合Mini-CEX模式能够进一步提高心脏外科实习生临床综合能力，本研究为临床教学方法的改进提供了一条新思路。

Application of modified lecture-based learning plus problem-based learning combined with mini-clinical evaluation exercise in clinical practice teaching of cardiosurgery

AIM To investigate the effects of modified lecture-based learning (LBL) plus problem-based learning (PBL) combined with mini-clinical evaluation exercises (Mini-CEX) in clinical practice teaching of cardiosurgery. METHODS Eighty intern students in our department of cardiosurgery from Jun. 2019 to Jun. 2021 were selected and they were randomized into LPL-PBL (LP) group (n=40) and LBL+PBL+Mini-CEX (LPM) group (n=40). The scores of Mini-CEX were compared between rotation to the department (T₁), 1 week of rotation (T₂), and 2 weeks of rotation (T₃) in the students of LPM group, and the theory examination scores and clinical skill performance scores (including medical history collecting and writing ability, physical examination, medical lab examination and test analysis ability, and basic surgical skill performance) were compared between LP group and LPM group. The students’ satisfaction of the teaching modes in the two groups was investigated by questionnaire. RESULTS In LPM group, the Mini-CEX rating scales in T₂ and T₃ were increased to varying degrees compared with those in T₁. All indexes in T₃ achieved excellence level and the rating scores were significantly enhanced compared with those in T₁ (P<0.05). The theory examination scores and clinical skill performance scores (including medical history collecting and writing ability, physical examination, medical lab examination and test analysis ability) were in LPM group were markedly higher than those in LP group, with statistically significant difference (P<0.05). However, no statistical differences in the basic surgical skill performance was found between the two groups. Additionally, the satisfaction of students in LPM group was significantly higher than that in LP group (P<0.05). CONCLUSION The modified LBL-PBL combined with Mini-CEX further improves the clinical comprehensive abilities of intern students in cardiosurgery. The present study provides a novel avenue for the improvement of clinical teaching methods.